Summary & Overview
CPT 19325: Breast Augmentation by Implant Placement
Headline: CPT code 19325: Breast augmentation by implant placement — national billing overview
Lead: CPT code 19325 designates surgical breast augmentation where an implant is placed to increase breast size and volume. The code is widely used across cosmetic and reconstructive practices and carries significance for payer coverage, facility billing, and surgical service-line planning.
What the code represents and why it matters: CPT code 19325 identifies a commonly performed elective and reconstructive procedure that affects practice revenue, prior authorization workflows, and benefit design. Nationally, its prevalence influences contracted rates, facility utilization, and surgical staffing needs.
Key payers covered: This overview addresses coverage and billing considerations relevant to Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: Readers will get a concise summary of clinical context, typical sites of service, common billing practices, and where to look for benchmarks and policy updates. The publication highlights payer coverage patterns, typical facility and professional billing distinctions, and areas where policy updates commonly arise (for example, medical necessity criteria and network prior authorization requirements).
Scope: Content is national in scope and intended for administrators, coders, and clinicians involved with surgical breast augmentation billing and reimbursement.
Billing Code Overview
CPT code 19325 describes a surgical procedure in which the provider increases the size and volume of the breast by placing a breast implant. This procedure is classified as a breast augmentation with implant placement.
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Service type: Surgical cosmetic/reconstructive procedure to augment breast volume
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Typical site of service: Outpatient surgical center or hospital operating room
Clinical & Coding Specifications
Clinical Context
A typical patient is a healthy adult presenting for elective breast augmentation to increase breast size and volume using silicone or saline implants. The workflow begins with a preoperative consultation documenting cosmetic goals, medical history, informed consent, and selection of implant type, size, and incision approach. Preoperative evaluation includes standard pre-op testing, anesthesia assessment, and marking of surgical sites. On the day of surgery, the patient undergoes general anesthesia in an ambulatory surgery center or hospital outpatient department. The surgeon creates the chosen pocket (subglandular, submuscular, or dual plane), places the implant, achieves hemostasis, and closes incisions. Postoperative care includes recovery room monitoring, discharge with wound care instructions and activity restrictions, and scheduled follow-up visits for incision check and implant position assessment. Typical sites of service are an ambulatory surgery center or hospital outpatient department. This procedure is elective and commonly performed by board-certified plastic surgeons or aesthetic breast surgeons.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default or unspecified modifier | Rarely used; reserved when no other modifier applies |
11 | No unusual procedural service | When the service is performed as typically expected without complications |
22 | Increased procedural services | When work or complexity substantially exceeds usual requirements (document rationale) |
50 | Bilateral procedure | For simultaneous augmentation of both breasts when bilateral reporting is required |
51 | Multiple procedures | When another distinct procedural CPT code is reported on the same day in addition to augmentation |
52 | Reduced services | When the service is partially reduced or not completed as originally planned |
53 | Discontinued procedure | If the procedure is started but terminated due to extenuating circumstances |
58 | Staged or related procedure by same physician | For planned staged augmentation or planned revision performed within the global period |
59 | Distinct procedural service | When a separate, distinct procedure is performed at the same session (use with caution) |
62 | Two surgeons | When two surgeons of different specialties work together as primary surgeons |
79 | Unrelated procedure or service by the same physician during the postoperative period | If an unrelated procedure is performed during the global period |
LT | Left side | To identify left-sided service when side-specific reporting is required |
RT | Right side | To identify right-sided service when side-specific reporting is required |
TC | Technical component | When billing only the facility/technical component of a service (rare for this CPT) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 208200000X | Plastic Surgery | Board-certified plastic surgeons commonly perform breast augmentation |
| 207V00000X | Otolaryngology (facial plastic) | Some facial/aesthetic surgeons with appropriate training may perform augmentation when credentialed |
| 208600000X | General Surgery | General surgeons with aesthetic training may perform breast procedures |
| 163W00000X | Obstetrics & Gynecology | Some OB/GYNs with cosmetic surgery training perform breast augmentation |
| 208Z00000X | Hand Surgery (Plastic Surgery Subspecialty) | Included as a plastic surgery subspecialty taxonomy; not commonly primary for this procedure |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
Z41.1 | Encounter for cosmetic surgery for purposes of appearance | Typical primary code when augmentation is elective cosmetic procedure |
Z42.0 | Encounter for breast reconstruction following mastectomy | Used when augmentation is part of reconstructive sequence post-mastectomy |
Z48.02 | Encounter for change or removal of surgical wound dressing | Relevant for postoperative wound care visits |
T85.49 | Other mechanical complication of other specified internal prosthetic devices, implants and grafts | Used for implant-related complications such as malposition or rupture |
N64.89 | Other specified disorders of the breast | Used when there are benign breast conditions assessed in perioperative evaluation |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
19316 | Mastopexy, breast | May be performed in combination with augmentation for ptosis correction (augmentation-mastopexy) |
19307 | Reduction mammoplasty | Performed when reduction is primary; not typical with augmentation but relevant in combined cosmetic breast surgeries |
15777 | Implantation of biologic implant (ADM) | May be used as an adjunct for implant coverage or support in select augmentation/revision cases |
11970 | Replacement of tissue expander with permanent implant | Relevant when prior reconstruction or expansion is converted to a permanent implant |
99024 | Postoperative follow-up visit, postoperative period | Used for routine post-op follow-up visits within the global period |